Diagnosis and management of pituitary abscess: a review of twenty-four cases

G. Edward Vates M.D., Ph.D. 1 , Mitchel S. Berger M.D. 1 and Charles B. Wilson M.D., M.S.H.A 1
View More View Less
  • 1 Department of Neurological Surgery, University of California at San Francisco, California
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. Pituitary abscess is a rare but serious intrasellar infection. To better determine the salient signs and symptoms that help in making the diagnosis, and to determine the most appropriate treatment, the authors reviewed their experience in a series of 24 patients treated at the University of California at San Francisco.

Methods. Nine of the patients were female and 15 were male, and their mean age was 41.2 years (range 12–71 years). Surprisingly, most patients in our series presented with complaints and physical findings consistent with a pituitary mass, but rarely with evidence of a serious infection. Headache, endocrine abnormalities, and visual changes were the most common clinical indicators; fever, peripheral leukocytosis, and meningismus were present in 33% or fewer of the patients. Imaging tests demonstrated a pituitary mass in all patients, but the features evident on computerized tomography and magnetic resonance studies did not distinguish pituitary abscesses from other, more common intrasellar lesions. Because of the ambiguous clinical features and imaging findings, most abscesses were not diagnosed before treatment; rather, the diagnosis was made during surgical exploration of the sella turcica, when the surgeon encountered a cystic mass containing pus. There were only two deaths in this series (8.3%). Patients presenting with headache and visual changes noted improvement in almost all cases; patients with endocrine dysfunction generally did not recover normal pituitary function, but were easily treated with hormone replacement therapy.

Conclusions. Antibiotic therapy is suggested for patients who have symptoms of sepsis, or for patients in whom specific organisms are identified from cultures obtained during surgery. The transsphenoidal approach is recommended over open craniotomy for surgical drainage.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: G. Edward Vates, M.D., Ph.D., Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, M 779, San Francisco, California 94143. email: vatese@neurosurg.ucsf.edu.
  • 1.

    Adams WM, , Laitt RD, & Thorne JA: MRI and CT in a case of pituitary abscess. Clin Radiol 54:270271, 1999 (Letter) Adams WM, Laitt RD, Thorne JA: MRI and CT in a case of pituitary abscess. Clin Radiol 54:270–271, 1999 (Letter)

    • Search Google Scholar
    • Export Citation
  • 2.

    Adeloye A: The enigma of pituitary abscess. Natl Med J India 10:228229, 1997 Adeloye A: The enigma of pituitary abscess. Natl Med J India 10:228–229, 1997

    • Search Google Scholar
    • Export Citation
  • 3.

    Arseni C, , Dănăilă L, & Carp N, et al: Intrasellar abscess. Neurochirurgia 18:207213, 1975 Arseni C, Dănăilă L, Carp N, et al: Intrasellar abscess. Neurochirurgia 18:207–213, 1975

    • Search Google Scholar
    • Export Citation
  • 4.

    Becker GL Jr, , Knep S, & Lance KP, et al: Amebic abscess of the brain. Neurosurgery 6:192194, 1980 Becker GL Jr, Knep S, Lance KP, et al: Amebic abscess of the brain. Neurosurgery 6:192–194, 1980

    • Search Google Scholar
    • Export Citation
  • 5.

    Bjerre P, , Riishede J, & Lindholm J: Pituitary abscess. Acta Neurochir 68:187193, 1983 Bjerre P, Riishede J, Lindholm J: Pituitary abscess. Acta Neurochir 68:187–193, 1983

    • Search Google Scholar
    • Export Citation
  • 6.

    Boggan JE: Pituitary abscess, in Wilkins RH, & Rengachary SS (eds): Neurosurgery, ed 2. New York: McGraw-Hill, 1996, Vol 3, pp 33213322 Boggan JE: Pituitary abscess, in Wilkins RH, Rengachary SS (eds): Neurosurgery, ed 2. New York: McGraw-Hill, 1996, Vol 3, pp 3321–3322

    • Search Google Scholar
    • Export Citation
  • 7.

    Bognàr L, , Szeifert GT, & Fedorcsàk I, et al: Abscess formation in Rathke's cleft cyst. Acta Neurochir 117:7072, 1992 Bognàr L, Szeifert GT, Fedorcsàk I, et al: Abscess formation in Rathke's cleft cyst. Acta Neurochir 117:70–72, 1992

    • Search Google Scholar
    • Export Citation
  • 8.

    Bossard D, , Himed A, & Badet C, et al: MRI and CT in a case of pituitary abscess. J Neuroradiol 19:139144, 1992 Bossard D, Himed A, Badet C, et al: MRI and CT in a case of pituitary abscess. J Neuroradiol 19:139–144, 1992

    • Search Google Scholar
    • Export Citation
  • 9.

    Dickob M, , Scharphuis T, & Distelmaier P, et al: Diagnostik des Hypophysenabszesses mittels MRI und hochauflösender CT. Neurochirurgia 32:184186, 1989 Dickob M, Scharphuis T, Distelmaier P, et al: Diagnostik des Hypophysenabszesses mittels MRI und hochauflösender CT. Neurochirurgia 32:184–186, 1989

    • Search Google Scholar
    • Export Citation
  • 10.

    Domingue JN, & Wilson CB: Pituitary abscesses. Report of seven cases and review of the literature. J Neurosurg 46:601608, 1977 Domingue JN, Wilson CB: Pituitary abscesses. Report of seven cases and review of the literature. J Neurosurg 46:601–608, 1977

    • Search Google Scholar
    • Export Citation
  • 11.

    Fong TC, , Johns RD, & Long M, et al: CT of pituitary abscess. AJR 144:11411142, 1985 Fong TC, Johns RD, Long M, et al: CT of pituitary abscess. AJR 144:1141–1142, 1985

    • Search Google Scholar
    • Export Citation
  • 12.

    Gatell JM, , Esmatjes E, & Serra C, et al: Diabetes insipidus and anterior pituitary dysfunction after staphylococcal meningitis and multiple brain abscesses. J Infect Dis 146:102, 1982 Gatell JM, Esmatjes E, Serra C, et al: Diabetes insipidus and anterior pituitary dysfunction after staphylococcal meningitis and multiple brain abscesses. J Infect Dis 146:102, 1982

    • Search Google Scholar
    • Export Citation
  • 13.

    Geokalp HZ, , Deda H, & Baeskaya MK, et al: Pituitary abscesses. Report of three cases. Neurosurg Rev 17:199203, 1994 Geokalp HZ, Deda H, Baeskaya MK, et al: Pituitary abscesses. Report of three cases. Neurosurg Rev 17:199–203, 1994

    • Search Google Scholar
    • Export Citation
  • 14.

    Gomez Perun J, , Eiras J, & Carcavilla LI: Abcès intrasellaíre au sein dún kuste de la poche de rathke. Neurochirurgie 27:201205, 1981 Gomez Perun J, Eiras J, Carcavilla LI: Abcès intrasellaíre au sein dún kuste de la poche de rathke. Neurochirurgie 27:201–205, 1981

    • Search Google Scholar
    • Export Citation
  • 15.

    Guigui J, , Boukobza M, & Tamer I, et al: Case report: MRI and CT in a case of pituitary abscess. Clin Radiol 53:777779, 1998 Guigui J, Boukobza M, Tamer I, et al: Case report: MRI and CT in a case of pituitary abscess. Clin Radiol 53:777–779, 1998

    • Search Google Scholar
    • Export Citation
  • 16.

    Güven MB, , Cirak B, & Kutluhan A, et al: Pituitary abscess secondary to neurobrucellosis. Case illustration. J Neurosurg 90:1142, 1999 Güven MB, Cirak B, Kutluhan A, et al: Pituitary abscess secondary to neurobrucellosis. Case illustration. J Neurosurg 90:1142, 1999

    • Search Google Scholar
    • Export Citation
  • 17.

    Heary RF, , Maniker AH, & Wolansky LJ: Candidal pituitary abscess: case report. Neurosurgery 36:10091013, 1995 Heary RF, Maniker AH, Wolansky LJ: Candidal pituitary abscess: case report. Neurosurgery 36:1009–1013, 1995

    • Search Google Scholar
    • Export Citation
  • 18.

    Henegar MM, , Koby MB, & Silbergeld DL, et al: Intrasellar abscess following transsphenoidal surgery. Surg Neurol 45:183188, 1996 Henegar MM, Koby MB, Silbergeld DL, et al: Intrasellar abscess following transsphenoidal surgery. Surg Neurol 45:183–188, 1996

    • Search Google Scholar
    • Export Citation
  • 19.

    Hwang SL, & Howng SL: Pituitary abscess: CT and MRI findings. J Form Med Assoc 95:267269, 1996 Hwang SL, Howng SL: Pituitary abscess: CT and MRI findings. J Form Med Assoc 95:267–269, 1996

    • Search Google Scholar
    • Export Citation
  • 20.

    Jadhav RN, , Dahiwadkar HV, & Palande DA: Abscess formation in invasive pituitary adenoma: case report. Neurosurgery 43:616619, 1998 Jadhav RN, Dahiwadkar HV, Palande DA: Abscess formation in invasive pituitary adenoma: case report. Neurosurgery 43:616–619, 1998

    • Search Google Scholar
    • Export Citation
  • 21.

    Jain KC, , Varma A, & Mahapatra AK: Pituitary abscess: a series of six cases. Br J Neurosurg 11:139143, 1997 Jain KC, Varma A, Mahapatra AK: Pituitary abscess: a series of six cases. Br J Neurosurg 11:139–143, 1997

    • Search Google Scholar
    • Export Citation
  • 22.

    Jung Y, , Kim JD, & Chadaga R, et al: Pituitary abscess following general sepsis in a diabetic patient. JAMA 235:1476, 1976 Jung Y, Kim JD, Chadaga R, et al: Pituitary abscess following general sepsis in a diabetic patient. JAMA 235:1476, 1976

    • Search Google Scholar
    • Export Citation
  • 23.

    Kabuto M, , Kubota T, & Kobayashi H, et al: Long-term evaluation of reconstruction of the sellar floor with a silicone plate in transsphenoidal surgery. J Neurosurg 88:949953, 1998 Kabuto M, Kubota T, Kobayashi H, et al: Long-term evaluation of reconstruction of the sellar floor with a silicone plate in transsphenoidal surgery. J Neurosurg 88:949–953, 1998

    • Search Google Scholar
    • Export Citation
  • 24.

    Kabuto M, , Kubota T, & Kobayashi H, et al: MR imaging and CT of pituitary abscess: case report and review. Neurol Res 18:495498, 1996 Kabuto M, Kubota T, Kobayashi H, et al: MR imaging and CT of pituitary abscess: case report and review. Neurol Res 18:495–498, 1996

    • Search Google Scholar
    • Export Citation
  • 25.

    Kashiwagi N, , Fujita N, & Hirabuki N, et al: MR findings in three pituitary abscesses. Case reports. Acta Radiol 39:490493, 1998 Kashiwagi N, Fujita N, Hirabuki N, et al: MR findings in three pituitary abscesses. Case reports. Acta Radiol 39:490–493, 1998

    • Search Google Scholar
    • Export Citation
  • 26.

    Kimura H, , Fukushima T, & Matsuda T, et al: [Abscess formation in a Rathke's cleft cyst]. No To Shinkei 46:392395, 1994 (Jpn) Kimura H, Fukushima T, Matsuda T, et al: [Abscess formation in a Rathke's cleft cyst]. No To Shinkei 46:392–395, 1994 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 27.

    Kingdon CC, , Sidhu PS, & Cohen J: Pituitary apoplexy secondary to an underlying abscess. J Infect 33:5355, 1996 Kingdon CC, Sidhu PS, Cohen J: Pituitary apoplexy secondary to an underlying abscess. J Infect 33:53–55, 1996

    • Search Google Scholar
    • Export Citation
  • 28.

    Larrañaga J, , Fandiño J, & Gomez-Bueno J, et al: Aspergillosis of the sphenoid sinus simulating a pituitary tumor. Neuroradiology 31:362363, 1989 Larrañaga J, Fandiño J, Gomez-Bueno J, et al: Aspergillosis of the sphenoid sinus simulating a pituitary tumor. Neuroradiology 31:362–363, 1989

    • Search Google Scholar
    • Export Citation
  • 29.

    Leff RS, , Martino RL, & Pollock WJ, et al: Pituitary abscess after autologous bone marrow transplantation. Am J Hematol 31:6264, 1989 Leff RS, Martino RL, Pollock WJ, et al: Pituitary abscess after autologous bone marrow transplantation. Am J Hematol 31:62–64, 1989

    • Search Google Scholar
    • Export Citation
  • 30.

    Leramo OB, & Char G: Intrasellar abscess simulating a pituitary tumour. West Indian Med J 38:171175, 1989 Leramo OB, Char G: Intrasellar abscess simulating a pituitary tumour. West Indian Med J 38:171–175, 1989

    • Search Google Scholar
    • Export Citation
  • 31.

    Marks PV, & Furneaux CE: Pituitary abscess following asymptomatic sphenoid sinusitis. J Laryngol Otol 98:11511155, 1984 Marks PV, Furneaux CE: Pituitary abscess following asymptomatic sphenoid sinusitis. J Laryngol Otol 98:1151–1155, 1984

    • Search Google Scholar
    • Export Citation
  • 32.

    Martines F, , Scarano P, & Chiappetta F, et al: Pituitary abscess. A case report and review of the literature. J Neurosurg Sci 40:135138, 1996 Martines F, Scarano P, Chiappetta F, et al: Pituitary abscess. A case report and review of the literature. J Neurosurg Sci 40:135–138, 1996

    • Search Google Scholar
    • Export Citation
  • 33.

    Medoc J, , Purriel JA, & Leiserson R: [Abscess of the pituitary gland and purulent meningitis]. Acta Neurol Latinoam 12:7175, 1966 (Spn) Medoc J, Purriel JA, Leiserson R: [Abscess of the pituitary gland and purulent meningitis]. Acta Neurol Latinoam 12:71–75, 1966 (Spn)

    • Search Google Scholar
    • Export Citation
  • 34.

    Neelon FA, & Mahaley MS Jr: Chiasmal syndrome due to intrasellar abscess. Arch Internal Med 136:10411043, 1976 Neelon FA, Mahaley MS Jr: Chiasmal syndrome due to intrasellar abscess. Arch Internal Med 136:1041–1043, 1976

    • Search Google Scholar
    • Export Citation
  • 35.

    Nelson PB, , Haverkos H, & Martinez AJ, et al: Abscess formation within pituitary tumors. Neurosurgery 12:331333, 1983 Nelson PB, Haverkos H, Martinez AJ, et al: Abscess formation within pituitary tumors. Neurosurgery 12:331–333, 1983

    • Search Google Scholar
    • Export Citation
  • 36.

    Obenchain TG, & Becker DP: Abscess formation in a Rathke's cleft cyst. Case report. J Neurosurg 36:359362, 1972 Obenchain TG, Becker DP: Abscess formation in a Rathke's cleft cyst. Case report. J Neurosurg 36:359–362, 1972

    • Search Google Scholar
    • Export Citation
  • 37.

    Obrador S, & Blazquez MG: Pituitary abscess in a craniopharyngioma. Case report. J Neurosurg 36:785789, 1972 Obrador S, Blazquez MG: Pituitary abscess in a craniopharyngioma. Case report. J Neurosurg 36:785–789, 1972

    • Search Google Scholar
    • Export Citation
  • 38.

    Post KD, , McCormick PC, & Bello JA: Differential diagnosis of pituitary tumors. Endocrinol Metab Clin N Am 16:609645, 1987 Post KD, McCormick PC, Bello JA: Differential diagnosis of pituitary tumors. Endocrinol Metab Clin N Am 16:609–645, 1987

    • Search Google Scholar
    • Export Citation
  • 39.

    Ramos-Gabatin A, & Jordan RM: Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine. Case report. J Neurosurg 54:839841, 1981 Ramos-Gabatin A, Jordan RM: Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine. Case report. J Neurosurg 54:839–841, 1981

    • Search Google Scholar
    • Export Citation
  • 40.

    Robinson B: Intrasellar abscess after transsphenoidal pituitary adenomectomy. Neurosurgery 12:684686, 1983 Robinson B: Intrasellar abscess after transsphenoidal pituitary adenomectomy. Neurosurgery 12:684–686, 1983

    • Search Google Scholar
    • Export Citation
  • 41.

    Rudwan MA: Pituitary abscess. Neuroradiology 12:243248, 1977 Rudwan MA: Pituitary abscess. Neuroradiology 12:243–248, 1977

  • 42.

    Sadun F, , Feldon SE, & Weiss MH, et al: Septic cavernous sinus thrombosis following transsphenoidal craniotomy. Case report. J Neurosurg 85:949952, 1996 Sadun F, Feldon SE, Weiss MH, et al: Septic cavernous sinus thrombosis following transsphenoidal craniotomy. Case report. J Neurosurg 85:949–952, 1996

    • Search Google Scholar
    • Export Citation
  • 43.

    Sahjpaul RL, & Lee DH: Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report. Neurosurgery 44:864868, 1999 Sahjpaul RL, Lee DH: Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report. Neurosurgery 44:864–868, 1999

    • Search Google Scholar
    • Export Citation
  • 44.

    Sato M, , Matsushima Y, & Taguchi J, et al: [A case of pituitary abscess caused by infection of Rathke's cleft cyst]. No Shinkei Geka 23:991995, 1995 (Jpn) Sato M, Matsushima Y, Taguchi J, et al: [A case of pituitary abscess caused by infection of Rathke's cleft cyst]. No Shinkei Geka 23:991–995, 1995 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 45.

    Schmutzhard E, , Willeit J, & Langmayr J, et al: Hypophysenabszess und zerebrale Arteriitis bei tödlich verlaufender Pneumokokkenmeningitis. Nervenarzt 59:176179, 1988 Schmutzhard E, Willeit J, Langmayr J, et al: Hypophysenabszess und zerebrale Arteriitis bei tödlich verlaufender Pneumokokkenmeningitis. Nervenarzt 59:176–179, 1988

    • Search Google Scholar
    • Export Citation
  • 46.

    Schwartz ID, , Zalles MC, & Foster JL, et al: Pituitary abscess: an unusual presentation of “aseptic meningitis.” J Pediatr Endocrinol Metab 8:141146, 1995 Schwartz ID, Zalles MC, Foster JL, et al: Pituitary abscess: an unusual presentation of “aseptic meningitis.” J Pediatr Endocrinol Metab 8:141–146, 1995

    • Search Google Scholar
    • Export Citation
  • 47.

    Shanley DJ, & Holmes SM: Salmonella typhi abscess in a craniopharyngioma: CT and MRI. Neuroradiology 36:3536, 1994 Shanley DJ, Holmes SM: Salmonella typhi abscess in a craniopharyngioma: CT and MRI. Neuroradiology 36:35–36, 1994

    • Search Google Scholar
    • Export Citation
  • 48.

    Sidhu PS, , Kingdon CC, & Strickland NH: Case report: CT scan appearances of a pituitary abscess. Clin Radiol 49:427428, 1994 Sidhu PS, Kingdon CC, Strickland NH: Case report: CT scan appearances of a pituitary abscess. Clin Radiol 49:427–428, 1994

    • Search Google Scholar
    • Export Citation
  • 49.

    Silver HS, & Morris LR: Hypopituitarism secondary to cavernous sinus thrombosis. South Med J 76:642646, 1983 Silver HS, Morris LR: Hypopituitarism secondary to cavernous sinus thrombosis. South Med J 76:642–646, 1983

    • Search Google Scholar
    • Export Citation
  • 50.

    Simmonds M: Ueber embolishe Prozesse in der Hypophysis. Virchow's Arch Pathol Anat 217:226239, 1914 Simmonds M: Ueber embolishe Prozesse in der Hypophysis. Virchow's Arch Pathol Anat 217:226–239, 1914

    • Search Google Scholar
    • Export Citation
  • 51.

    Sonntag VKH, , Plenge KL, & Balis MS, et al: Surgical treatment of an abscess in a Rathke's cleft cyst. Surg Neurol 20:152156, 1983 Sonntag VKH, Plenge KL, Balis MS, et al: Surgical treatment of an abscess in a Rathke's cleft cyst. Surg Neurol 20:152–156, 1983

    • Search Google Scholar
    • Export Citation
  • 52.

    Takahashi T, , Shibata S, & Ito K, et al: Neuroimaging appearance of pituitary abscess complicated with close inflammatory lesions—case report. Neurol Med Chir 38:5154, 1998 Takahashi T, Shibata S, Ito K, et al: Neuroimaging appearance of pituitary abscess complicated with close inflammatory lesions—case report. Neurol Med Chir 38:51–54, 1998

    • Search Google Scholar
    • Export Citation
  • 53.

    Tanigawa K, , Yamashita S, & Namba H, et al: Acute adrenal insufficiency due to symptomatic Rathke's cleft cyst. Intern Med 31:467469, 1992 Tanigawa K, Yamashita S, Namba H, et al: Acute adrenal insufficiency due to symptomatic Rathke's cleft cyst. Intern Med 31:467–469, 1992

    • Search Google Scholar
    • Export Citation
  • 54.

    Thomas N, , Wittert GA, & Scott G, et al: Infection of a Rathke's cleft cyst: a rare cause of pituitary abscess. Case illustration. J Neurosurg 89:682, 1998 Thomas N, Wittert GA, Scott G, et al: Infection of a Rathke's cleft cyst: a rare cause of pituitary abscess. Case illustration. J Neurosurg 89:682, 1998

    • Search Google Scholar
    • Export Citation
  • 55.

    Wolansky LJ, , Gallagher JD, & Heary RF, et al: MRI of pituitary abscess: two cases and review of the literature. Neuroradiology 39:499503, 1997 Wolansky LJ, Gallagher JD, Heary RF, et al: MRI of pituitary abscess: two cases and review of the literature. Neuroradiology 39:499–503, 1997

    • Search Google Scholar
    • Export Citation
  • 56.

    Zorub DS, , Martinez AJ, & Nelson PB, et al: Invasive pituitary adenoma with abscess formation: case report. Neurosurgery 5:718722, 1979 Zorub DS, Martinez AJ, Nelson PB, et al: Invasive pituitary adenoma with abscess formation: case report. Neurosurgery 5:718–722, 1979

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1153 801 36
Full Text Views 412 58 3
PDF Downloads 203 34 3
EPUB Downloads 0 0 0